Efforts to address patient dumping problem move forward.

In any given year, approximately 3.5 million Americans experience homelessness, 39 percent of whom are children. Why we allow so many people to live in abject poverty and desperation is an indictment against our humanity; it most certainly tarnishes the badge our nation flashes to the rest of the world when we claim to be the standard bearer on human rights. In partial defense, though, those who study homelessness readily acknowledge that lasting solutions are elusive because homelessness is a multidimensional and complex problem.

Though no statistics are kept on the numbers of homeless treated by hospitals in Los Angeles, 75 hospitals with emergency rooms are the medical safety net for the estimated 80,000 homeless residing in the county, including the almost 1,200 who congregate daily on the streets of Skid Row in downtown Los Angeles. In fact, these hospitals are required by law to receive, treat and stabilize any of the county's almost 3 million uninsured residents who present with life-threatening illnesses or injuries, and they meet this obligation at a collective financial loss of approximately $1.6 billion annually.

The burden of being the medical safety net for the uninsured has damaged the integrity of the emergency medical services system we all rely on. Ten hospital emergency rooms serving communities throughout our county closed in the last five years. Of the remaining emergency rooms, at any given time one in four is closed to emergency ambulance patient deliveries because overcrowded conditions threaten to compromise safety and the quality of medical care delivered. Overcrowded conditions also are the root cause of the seven-hour average emergency room waiting times for non-emergency medical treatment.

These conditions compel doctors to discharge patients as soon as the medical condition that brought them in no longer requires acute hospital attention and treatment. Costs have to be constrained to keep more emergency rooms from closing and scarce hospital beds must be cleared quickly of patients no longer needing medical treatment to make way for new patients. Before patients leave the hospital, though, discharge planners try to arrange for the services that the patient-care team says are needed. This process is often complicated by the fact that too few shelter beds and support services are available for homeless patients.

On behalf of hospitals serving communities throughout Los Angeles County, the Hospital Association of Southern California is working with non-profit organizations, the L.A. County Health Department and homeless service agencies to address the issues that Los Angeles City Attorney Rocky Delgadillo raised last November with regard to homeless patients being sent to Skid Row in downtown Los Angeles after being treated by hospitals. In response, the association is very close to completing plans that would connect patients no longer needing hospital care with transitional services.

First, hospitals that serve the downtown area will call the Volunteers of America to pick up homeless patients no longer needing hospital care. The VOA will transport and hand these former patients off to homeless service providers. No more taxis or ambulance drop-offs. If successful, this service will be expanded to include other hospitals in the county.

Next, the number of recuperative beds now available in the county to transition homeless patients no longer needing hospital care will be increased from 40 to 95, a long overdue service enhancement. Private hospitals, non-profit agencies, and Los Angeles County will fund this new homeless bed capacity.

Last, the hospital association and homeless service providers are designing a standardized service referral form and process to be used by hospitals with homeless patients. Moreover, a training program for all hospital workers involved in planning the post-hospital care for homeless patients will soon come on line.

Delgadillo is aware of these efforts. That's why many are perplexed by his decision to use his prosecutorial authority against hospitals to address the problem of homelessness. That seems to be a rather excessive, pernicious approach to solving a problem that hospitals have agreed needs to be addressed and are addressing.

Hospitals should not be vilified by elected officials who are frustrated over not being able to solve this complex problem. After all, hospitals do provide medical care to the homeless with no expectation of ever being paid for doing so, and the industry has stepped up to the plate with specific proposals for real solutions to patient dumping.

The industry needs our government officials' help with solving this problem. At an average cost of $1,286 per day, no reasonable or thinking individual wants hospitals to house the homeless when they no longer need medical care.

James Lott is executive vice president of the Hospital Association of Southern California.

TWO VIEWS

City Attorney Rocky Delgadillo's office last month sued Kaiser Permanente for allegedly transporting a discharged patient, a homeless woman, to Skid Row and dropping her off on the street near a mission. The practice, called homeless dumping, has gotten a good deal of press attention. These two views on the issue--one from a hospital association and the other from a Skid Row mission--were written for the Business Journal.